July / August 2011 | Volume 10, Issue 4

Diabetes, heart disease and other NCDs account for nearly two-thirds of all deaths worldwide.

By Steve Goldstein

It is not only possible, but essential, to deploy comprehensive strategies to address noncommunicable diseases (NCDs) in low- and middle-income countries, and these should offer cost-effective treatment alongside prevention in a mutually reinforcing way.

That was the message delivered by Harvard School of Public Health Dean Dr. Julio Frenk, the keynote speaker at a session devoted to the epidemic of NCDs at the Global Health Council’s annual conference in Washington, D.C. Frenk headlined an impressive cast of speakers appearing on two panels, one devoted to the major risk factors for NCDs and the other addressing innovative multisectoral approaches to controlling these diseases.

Introducing Frenk, Fogarty Director Dr. Roger I. Glass described the purpose of the meeting as highlighting "the instrumental role that research will play in thinking about the chronic and noncommunicable disease agenda."

The research symposium, organized by NIH, served as part of the run-up to the U.N. General Assembly’s High-Level Meeting on NCDs scheduled for September. Frenk noted the urgency of the epidemic: 80 percent of the deaths attributed to NCDs occur in low- and middle-income countries. U.N. estimates say that cancer, heart and lung disease, diabetes and other NCDs account for nearly two-thirds of all deaths worldwide.

Frenk dismissed what he called the "false dichotomies," such as the idea that no NCDs have genetic or infectious causes, and urged the global health agenda to embrace integration of different levels of care. "I have always seen global health as a crossroads where multiple dimensions intersect: biology and society, individual and population, evidence and ethics, analysis and action," Frenk declared.

Panelists Dr. David G. Marrero of Indiana University, Dr. Nancy A. Rigotti of Harvard Medical School and Dr. Douglas R. Lowy, deputy director of the National Cancer Institute addressed diabetes, tobacco and cervical cancer, respectively. Marrero advocated community-based partnerships to facilitate successful interventions in obesity-caused diabetes. Rigotti, noting that tobacco usage is responsible for one in 10 deaths worldwide, said the toll is expected to worsen in the 21st century.

"We have effective treatments, but we need better ones," Rigotti said. She noted that only 25 percent of American smokers who try to quit seek help. "If this is true in developed countries, what about the rest of the world?" she asked.

Lowy spoke of the importance of the identification of human papillomavirus as the cause of the cervical cancer. Until an affordable vaccine is widely available, screening remains an essential means to curtail mortality.

Sir Peter Gluckman, a biology professor at the University of Auckland and chief science adviser to the Prime Minister of New Zealand, said that a poor start to life is a strong determinant for obesity, diabetes and heart disease, among other afflictions. Early intervention in maternal health is vital, Gluckman explained, because it has been found that the first 1,000 days of life determine such characteristics as tastes, satiety and energy expenditure.

Also on the second panel were Deputy Assistant Secretary of State Nerissa J. Cook and Dr. Scott C. Ratzan, a government affairs executive with Johnson & Johnson. Cook emphasized the significance of the upcoming UN high-level meeting as crucial to multilateral "health diplomacy" to increase the involvement of international partners. Ratzan advocated the use of a risk-based "scorecard" to measure up to seven indicators that will account for 70 percent of chronic diseases.